Immune cells enter the central nervous system (CNS) from the circulation under normal conditions for immunosurveillance and in inflammatory neurologic diseases. This review describes the distinct anatomic features of the CNS vasculature that permit it to maintain parenchymal homeostasis and which necessitate specific mechanisms for neuroinflammation to occur. We review the historical evolution of the concept of the blood-brain barrier and discuss distinctions between diffusion/transport of solutes and migration of cells from the blood to CNS parenchyma. The former is regulated at the level of capillaries, whereas the latter takes place in postcapillary venules. We summarize evidence that entry of immune cells into the CNS parenchyma in inflammatory conditions involves 2 differently regulated steps: transmigration of the vascular wall into the perivascular space and progression across the glia limitans into the parenchyma.
The interface between the immune and nervous systems has long fascinated both immunologists and neuroscientists. This is best exemplified at the most prominent interface between these systems, the blood-brain barrier (BBB). In discussions of clinical and experimental inflammatory brain diseases, brain homeostasis, and psychology, the BBB takes on almost mystical significance. It is striking, however, how many different versions of the BBB one can encounter in such discussions, depending on the focus of the discussants. We and others have reviewed this topic in other forums but felt it would be useful to focus on the anatomic and physiologic intricacies of the BBB with reference to its pathobiologic functions. We emphasize the concept that cellular transmigration across the BBB is not a single-step phenomenon as occurs in other tissues, but that it involves 2 distinct processes that overlap within the perivascular space. This 2-step nature of cellular migration into the central nervous system (CNS) imposes specific constraints that are fundamental to understanding many facets of neuroimmunology and CNS pathophysiology.
Morphology of the Neurovascular Unit: Vascular Wall, Perivascular Space, and Glia Limitans
The topography and architecture of CNS microvessels are designed for 2 major site-specific tasks. First, because neuronal activity within the CNS strictly depends on homeostasis, the microvasculature of the brain must prevent ions and other solutes in the blood from entering the parenchyma. Second, to enhance regional blood flow wherever it is needed, the vascular tree has to have the capacity to respond rapidly to neuronal activity. The first task is reflected by the term BBB; the second is referred to as “neurovascular coupling.” Both the differentiation of BBB-typical endothelial cells and the response of the vessels to enhanced electric activity seem to depend in various ways on astrocyte signaling provided at a unique structure, the glia limitans (Fig. 1). The glia limitans is composed of astrocyte processes and covers the entire surface of the brain and spinal cord on the external face, toward the subarachnoid space (glia limitans superficialis), and internally around the vessels (glia limitans perivascularis; Fig. 2A).
By definition, capillaries in all organs lack a tunica media of smooth muscle cells. Capillary endothelial cells in the CNS are surrounded by large numbers of pericytes that are embedded into the vascular basement membrane, which is directly attached to the glia limitans (Fig. 2C). This contrasts with CNS arteries and veins in which the distance between the endothelial layer and the glia limitans is much larger because there are various layers of intervening smooth muscle cells. In postcapillary CNS venules, there is an intermediate situation with a perivascular space and the presence of “mural cells” within the endothelial basement membrane (Fig. 2B); these have characteristics of pericytes or vascular smooth muscle cells (1).
As they pass from the subarachnoid space into the deep areas of the brain, the large vessels are surrounded by a connective tissues consisting of leptomeningeal mesothelial cells, macrophages, and other antigen-presenting cells comprising the cellular components of the perivascular space (Fig. 2A). Thus, perivascular spaces are located between the basement membrane of the vascular wall and the basement membrane of the glia limitans and are continuous with the subarachnoid space (Fig. 1B). In the capillary segment, the basement membranes contain laminins 411 and 511, whereas in the glia limitans, they contain laminins 111 and 211; the latter fuse to form a “gliovascular membrane” that closes the perivascular space (Fig. 2D) (2). As a consequence, a unidirectional flow of extracellular fluids from the parenchyma along perivascular spaces into the subarachnoid space can be driven by the arterial pulse; this substitutes for the lack of lymphatic drainage in the brain (3).
Where/What is the BBB?
The term BBB describes the phenomenon that was first observed by Paul Ehrlich (4) in the course of his studies with “intravital dyes.” These hydrophilic compounds can be injected into the blood and change their color depending on their oxidative state. Ehrlich's goal was to compare the oxygen consumption of different organs based on the color they exhibited upon dye injection. A prerequisite of this approach was that the dye should be equally distributed within the body at the beginning of the experiment, but Ehrlich noted that this was not the case. In particular, the brain exhibited little or no staining. He therefore concluded that the brain lacks affinity for these dyes. Continuing with this work, Biedl and Kraus (5) injected bile acids into the CNS, and the Berlin physician Lewandowski (6) injected sodium ferrocyanide into the CNS, from which he concluded that the “capillary wall must block the entrance of certain molecules” not normally present in the blood. This was the first time that a special barrier function was postulated for brain capillary endothelial cells.
The development of electron microscopy allowed further focus on the “barrier.” Reese and Karnovsky (7) were the first to describe the unique belt-like tight junctions in brain capillary endothelial cells, which they regarded as correlates of a BBB. In addition, they noted “a paucity” of transportation vesicles that linked the concept of a barrier to more dynamic processes. Indeed, we now know that in addition to the mechanical barrier maintained by tight junctions at the capillary level, a number of permanently active transportation mechanisms contribute to excluding blood molecules that could harm the parenchymal milieu necessary for neural transmission (8).
The term BBB thus provides a metaphorical explanation for a phenomenon first noted by Ehrlich rather than pointing to a single anatomic structure or mechanism. In fact, much confusion comes from attempts to translate the concept of a BBB into the field of cellular neuroinflammation. Whereas the permission or restriction of passage of molecules from the blood is a major function of capillaries, immune cells are recruited to the CNS at the level of postcapillary venules; the architecture and topographic relationships of these vessels to the brain parenchyma are strikingly different due to the existence of mural cells and perivascular spaces. The width of perivascular spaces is variable in the healthy CNS (Fig. 1B). Distance from the glia limitans seems to affect astrocyte signaling on endothelial cell differentiation; and therefore, notable differences have been described in the organization of tight junctions in capillaries compared with precapillary and postcapillary vessels (Figs. 2C, E) (9). Unfortunately, a systematic ultrastructural study of the molecular composition of tight junctions in capillaries versus in postcapillary venules has not yet been performed. It is not generally appreciated that it is only at first glance that markers of the BBB such as horseradish peroxidase (HRP) do not leave the blood stream and enter the brain when they are injected into the circulation (10). A closer look reveals that HRP staining can be observed in the vascular wall of larger vessels and in macrophages of the perivascular spaces and the choroid plexus, which thus act as substitutes of BBB function at the precapillary and postcapillary levels; their capacity to act as phagocytic scavengers compensates for the enhanced endothelial layer permeability in these areas of the vascular tree. This additional level of regulation of diffusion from the blood into the parenchyma of the brain prompted Goldmann (11) to propose the notion of a “physiologic bordering membrane” consisting of highly phagocytic macrophages in 1913. Since then, the penetration of BBB markers through noncapillary brain vessels has remained the neuroanatomists' “dirty little secret” (12, 13). Nevertheless, it can be concluded that the mechanisms that maintain a barrier for solutes in postcapillary venules involve additional components.
From studies of bone marrow chimeras, it became evident that the population of perivascular macrophages is regularly exchanged by hematogenous precursors in the absence of pathologic processes in the brain parenchyma (14-16). In light of the more recent appreciation of the effects of irradiation on cellular recruitment into the brain (17), it is noteworthy that this exchange also occurs in nonirradiated rats (18). Thus, monocytes can apparently cross the vascular wall of brain vessels under normal conditions. They do not, however, normally progress through the glia limitans into the neuropil, but are retained in perivascular spaces. Only when there is intraparenchymal damage such as axonal degeneration or inflammation, as in multiple sclerosis (MS) or its animal model experimental autoimmune encephalomyelitis (EAE), does the glia limitans become permissive for monocytes to migrate into the neuropil; some of them may then transform into microglia (15, 19, 20). For example, Babcock et al (21) showed that the chemokine monocyte chemotactic protein 1 (CC-ligand 2) produced by astrocytes and microglia is a critical factor driving the recruitment of monocytes into areas of Wallerian degeneration.
Two distinct steps can also be distinguished for T-cell migration into the CNS parenchyma. One group also demonstrated that the elimination of perivascular macrophages did not interfere with perivascular infiltration after the induction of EAE in mice, but the progression of T cells across the glia limitans was completely blocked (22). Thus, macrophages and/or antigen recognition seem to be required for T cells to perform the second step of migration. The Angelov group showed that sensitizing rats with HRP and subsequently injecting HRP into their subarachnoid space led to diffusion along perivascular spaces and phagocytosis of HRP by perivascular macrophages. When the animals were immunologically boosted with HRP, T cells entered the perivascular spaces but did not cross the glia limitans; they were essentially put “on hold” in the perivascular compartment (23). Similarly, deletion of both matrix metalloprotease (MMP) 2 and MMP-9 confers resistance to EAE by trapping leukocytic infiltrates in the perivascular space, suggesting that MMPs produced by macrophages are required for leukocyte infiltration across the glia limitans (24).
Thus, the term BBB in the context of infiltration of leukocytes into the CNS parenchyma can be confusing. Physiologically, the term refers to the vascular segment of the capillaries that regulate diffusion of solutes, whereas in an inflammatory response, the term refers to the postcapillary venules, that is, the vessels from which leukocytes migrate into the CNS. These are distinct vascular segments (25). For leukocytes to reach the CNS parenchyma, they need to perform 2 differently regulated steps: first, to cross the vascular wall, and second, to traverse the glia limitans (Fig. 3). Understanding the distinct molecular mechanisms is critical because it seems that activated lymphocytes regularly penetrate the endothelial barrier for immunosurveillance of the CNS, but only upon penetration of the glia limitans and infiltration of the CNS parenchyma do leukocytes come into direct contact with the parenchyma, which leads to clinical disease.
Migration Across the Vascular Wall and (Sometimes) Progression Across the Glia Limitans
As previously described, there are 2 principal physical barriers to cellular entry to the CNS parenchyma, the vascular endothelium and the glia limitans, each with its own basement membrane. The perivascular space between them represents not so much a barrier as a regulatory checkpoint that depends on the precise anatomic localization and the immune status of the patient or animal.
Migration of leukocytes across the vascular wall is governed by adhesion molecules, cytokines, chemokines, and their receptors. These are integrated in a sequential process of leukocyte-endothelial cell interaction that was first formulated by Butcher (26) and Dustin and Springer (27). The molecular mechanisms involved in the multistep paradigm of leukocyte recruitment across the vascular wall have been extensively reviewed (26-29). Briefly, leukocytes in the so-called “fast lane” of in the vessel lumens engage with inflamed endothelium via tethering and rolling (i.e. slowing) and are triggered by chemokine gradients to higher affinity adhesion, locomotion, and frank adhesion before they cross the vascular wall (diapedesis; Fig. 4).
CNS Address and Welcome Mats
Tissue-specific “area codes” are combinations of adhesion and signaling ligands that are expressed selectively or at higher levels in the CNS vasculature and are thought to favor interactions with leukocytes that express the specific selection of appropriate counterligands. The area code concept would explain selective migration of leukocytes to different anatomic regions such as the CNS, although the precise molecular composition of CNS area codes has not yet been defined. At present, there are no CNS-specific endothelial cell adhesion ligands that are absolutely specific. Certain combinations, however, can favor leukocyte interactions with cerebral or spinal cord endothelial cells. For example, whereas most circulating leukocytes express the adhesion molecule L-selectin ligand (CD62-L), a subset of activated or memory-effector T cells have downregulated L-selectin. Therefore, they are less likely to reenter lymph nodes from the circulation, and their migration may favor the CNS. The selectins and the selectin ligand P-selectin glycoprotein ligand 1 are not required for leukocyte infiltration across CNS microvessels such as in EAE (29, 30), and in mice, a counterligand for α4-integrins, vascular cell adhesion molecule 1, is constitutively expressed on spinal cord endothelial cells and mediates the capture and firm adhesion of T-cell blasts via α4-integrin (31,32).
Selectins are a family of carbohydrate-recognizing cell surface proteins (calcium-dependent C-type lectins) that are widely expressed both by leukocytes and endothelial cells. Selectin-driven tethering promotes rolling and permits the slowed-down leukocytes to be triggered by local gradients of immobilized chemokines. The process is selective in that those blood cells with appropriate chemokine receptors will then proceed to subsequent integrin activation (inside-out signaling), locomotion to sites of entry, and tight adhesion (28). The fact that selectins are not equally required for tethering adhesion in the inflamed CNS vessels influences the design of therapies directed against entry of potentially pathogenic leukocytes (29,33).
Integrin interactions mediate firm leukocyte adhesion and are therefore likely targets for therapy. The efficacy of α4-integrin-directed immunotherapy in MS represents an important proof-of-principle in this regard because it opens up possibilities that other adhesion molecule-ligand interactions may be useful drug targets (31). The recent identification of a role for the adhesion ligand-activated leukocyte cell adhesion molecule or CD166 in CD6+ CD4+ T-cell interactions with cerebral endothelial cells is a potential candidate for this therapeutic approach (34).
Integration of Autoimmune and Infectious Immune Principles
The multistep paradigm is also applicable to immune responses to CNS infections. In the skin, local virus infections induce the trafficking of antigen-presenting Langerhans cells to lymph nodes where, as dendritic cells, they induce a memory-effector T-cell response that is then directed to the site of infection via local inflammation (28). A role for local inflammation in this process is noteworthy. In contrast, EAE in rodents can be induced by adoptive transfer to an unmanipulated recipient of activated CD4+ T cells that have specificity for myelin peptides. Alternatively, it can be induced by subcutaneous immunization with these myelin peptides in adjuvant in susceptible rodent strains. Although many of the actively induced EAE models involve pertussis toxin, it is not needed for disease induction either by immunization or in adoptive transfer in certain rodent strains. It may, however, increase the disease incidence (35); thus, in these models, a CNS-specific disease can be induced without the use of adjuvant or preexisting local inflammation. One interpretation of these observations is that whether leukocyte interaction with CNS endothelium results in extravasation or disease may be determined by the sum of the molecular interactions between them. This presumes that highly activated T cells that have sufficiently elevated levels of adhesion molecules and cytokine/chemokine production can elicit responses from an otherwise quiescent vascular endothelium. In support of this concept, T-cell diapedesis across noninflamed retinal microvessels fails until the interaction has induced endothelial intercellular cell adhesion molecule 1 expression, which probably triggers the extravasation (36). Moreover, T-cell-derived tumor necrosis factor can elicit a chemokine response from BBB-associated cells, principally dendritic cells/macrophages/pericytes/microglial cells (37). The activation status of the T cell is critical to this process because only freshly activated T cells can transfer EAE and productively interact with the noninflamed BBB (32). The extent to which activated T cells and local inflammation (e.g. resulting from infection or other local CNS responses) may be involved in CNS inflammation in MS is not known.
In Vitro Models
In vitro models of CNS endothelium have resulted in many advances in our understanding of the BBB. Specific in vitro models mimic many aspects of live animals, but a full neurovascular unit is too complex to reproduce in vitro at present. Cocultures of cerebral endothelial cells with apposed astrocytes that induce a tight junctional barrier in vitro have been designed to model the capillary BBB and investigate the passage of solutes across this vascular bed (37). Recently, these systems have been adapted to model postcapillary venules where astrocytes and endothelia are not in intimate contact, that is, more closely mimicking postcapillary venules (32).
Exchange and Turnover of Cells in the Perivascular Space
Cellular migration across the BBB is recognized as a critical step for CNS inflammation. Seminal studies by Hickey and Kimura (14) showed that for induction of EAE, encephalitogenic T cells and bone marrow-derived cells in CNS, presumed to be at the BBB, should share expression of major histocompatibility complex (MHC), or be MHC-compatible. Further studies by Hickey et al (38) and by Sedgwick et al (39) determined that a population of perivascular macrophages is replaced in radiation chimeras, distinct from parenchymal microglia, which are not. This observation points to the ability of blood-derived cells to exchange within the perivascular space, that is, at least some blood-derived cells cross the vascular endothelium under normal circumstances. These would be the relevant MHC-matched cells with which T cells must interact. This is consistent with the observation that dendritic cells, which are usually found in extraparenchymal locations (e.g. the perivascular and subarachnoid spaces and meninges), are critical for the induction of EAE (40).
Is There Antigen-Driven Interaction Between T Cells and Endothelia?
It is uncertain whether endothelial cells present antigen to CD4+ T cells for the induction of CNS inflammation. The relative absence of expression of the CD4 ligand MHC II on normal endothelium and the fact that EAE can be adoptively transferred to naive recipients suggest that antigen-driven interactions between CD4+ T cells and endothelial cells are not necessary for their extravasation. The logic behind this argument contributes to interpretation of data (41, 42) showing that naive CD4+ T cells can access the CNS. Endothelial cells can be induced to express MHC II and costimulatory molecules in vitro, and this may identify the capacity of endothelial cells to present antigen. Some observations in situ, however, do not support this (43, 44), suggesting more cautious interpretation. Expression of such molecules was increased in disease-associated endothelial inflammation in autopsy material (45), but this may represent a post hoc effect relative to the initial T-cell entry that is the focus here. The observation that adhesion of CD4+ T cells is increased when activated endothelial cells express costimulatory molecules CD40, B7.1/CD80, or B7.2/CD86 (46, 47) likely has functional significance but does not prove antigen recognition in vivo.
A constitutive low level of the CD8 ligand MHC I on cerebral endothelium suggests that migrating CD8+ T cells may engage in antigen recognition (48). In that study, naive CD8+ T cells were detected in the side of the brain in which cognate peptide had been injected, and this was blocked by antibody against MHC I, which could only access the luminal endothelial surface (48). The authors' interpretation of the absence of T cells in the contralateral brain, in which an irrelevant antigen was injected, that CD8+ T cells could only enter if antigen was presented, is valid only if a transient “look-and-leave” entry can be excluded. The issue turns on whether egress or reverse migration contributes to net effects (see following).
Egress or reverse migration is difficult to measure (49). One recent study described cells that were assumed to have left the CNS (50), but consideration of cellular exit from the CNS can confound interpretation of in vivo analyses. For example, the failure to detect T cells within the CNS cannot be taken to show that they did not enter the CNS. When T cells are detected, it is presumed to be the net result of entry plus either proliferation or accumulation (51). The concept of immunosurveillance predicts that potentially protective T cells should be able to access all tissues, which can be extended to include that in the absence of functional antigen presentation, they may either leave again or die in situ (veni, vidi, vici or veni, mori 52).
Transcellular Versus Paracellular Routes of Migration
Leukocytes may go through endothelial cells (transcellular route) or go between them (paracellular route). Transcellular migration was originally described by Marchesi and Gowans (53) in electron microscope studies that showed “emperipolesis,” whereby lymphocytes were enveloped by cells at vascular walls. Which molecular mechanisms trigger transcellular versus paracellular diapedesis is presently unclear; the use of both routes in different vascular beds has been described for both lymphocytes and neutrophils (53, 54). In the CNS, the passage between endothelial cells would necessitate the disruption of the complex tight junctions; molecular interactions with the junctional molecules claudins, occludin, junctional adhesion molecules, CD99, and Zonula occludens molecules would be involved (54). Although there is accumulating evidence for transcellular diapedesis of leukocytes across the BBB during inflammation (54), the molecular mechanisms remain to be investigated. The functional and structural characteristics.
Migration Across the Glia Limitans and Its Regulation
The glia limitans seems to be the site at which MMPs play the most significant role in leukocyte migration. Toft-Hansen et al (57) showed that, whereas a broad-spectrum MMP inhibitor did not affect the subclinical perivascular accumulation of leukocytes in a transgenic mouse expressing the chemokine CC-ligand 2 in the CNS, MMP inhibition blocked leukocyte entry into CNS parenchyma induced by pertussis toxin. This indicates that chemokine-driven crossing of the endothelium and perivascular leukocyte accumulation was not dependent on MMPs, whereas they were critical for migration across the glia limitans. The specific MMPs involved were not identified in that study. As previously mentioned, however, in EAE, MMP-2 and MMP-9 proteolytically cleave dystroglycan, which anchors astrocyte endfeet to the glia limitans basement membrane via binding to the extracellular matrix molecules agrin and perlecan (24). Moreover, staining for the transmembrane β-dystroglycan isoform is lost in the pertussis toxin-treated myelin basic protein promoter-driven CC-ligand 2 transgenic mice, indicating that dystroglycan breakdown occurs in this model (Füchtbauer et al, unpublished observation).
The glia limitans is not as accessible to in vitro analysis as the cerebrovascular endothelium. Nevertheless, there currently is a consensus that chemokines and integrins exert their major effects at the vascular endothelium, whereas MMPs have more prominent roles in glia limitans breakdown. Astrocytes are a potential source of chemokines at the BBB and probably contribute significantly to perivascular chemokine levels under physiologic conditions (58, 59). Another contribution that astrocytes make is modifying overall BBB permeability. Several groups have shown that permeability of artificial BBB endothelial monolayers to macromolecules is significantly decreased by coculture with astrocytes or by treatment with astrocyte-derived soluble factors (60, 61). In a recent study that showed expression of angiotensin receptors at the BBB in MS brain and on endothelial cells in vitro, Wosik et al (62) reported that astrocytes can modify expression and phosphorylation of the endothelial cell tight junction-associated molecule occludin via release of angiotensin. Rodent astrocytes have also been reported to express AT1 angiotensin receptors and may respond to vascular tension-regulatory hormones (63-65).
The Blood-Cerebrospinal Fluid Barrier as Possible Entry Site of Immune Cells into the CNS
In contrast to the classical endothelial BBB, the epithelial blood-cerebrospinal fluid (CSF) barrier of the choroid plexus epithelium has not, until very recently, been considered to be an entry site for immune cells or pathogens into the CNS (66). The choroid plexus extends from the ventricular surface into the lumen of the ventricles; its major known function is the secretion of CSF. It is organized in a villous surface, including an extensive microvascular network enclosed by a single layer of cuboidal epithelium (67). The microvessels within the choroid plexus parenchyma differ from those of the brain parenchyma because they allow free movement of molecules via fenestrations and intercellular gaps (68). The functional barrier between the blood compartment and the CSF is located at the level of the choroid plexus epithelial cells that form tight junctions that inhibit paracellular diffusion of water-soluble molecules (69). These tight junctions are the morphologic correlate of the blood-CSF barrier and have a unique molecular composition of transmembrane proteins with occludin, claudin-1 and claudin-2, and claudin-11 (69).
Regional Differences in CNS Microvessels: Parenchyma, Leptomeninges, and Circumventricular Organs
In addition to the choroid plexus, there are structures in the CNS of mammals that lack an endothelial BBB. These areas are commonly referred to as the circumventricular organs (CVOs) and perform homeostatic and neurosecretory functions; the neurons within them monitor hormonal stimuli and other substances within the blood or secrete neuroendocrines into the blood (70, 71). Circumventricular organs are localized at strategic points close to the midline of the brain within the ependymal walls lining the third and fourth ventricles. Because they lack an endothelial BBB, they lie within the blood milieu and thus form a blood-CSF barrier. Similar to the choroid plexus, a complex network of tight junctions connecting specialized ependymal cells (tanycytes) seal off the CNS from the CVOs (71, 72). Although the CVOs have often been referred to as “windows of the brain” with respect to soluble mediators, entry of immune cells into the brain via the CVOs across the tanycytic barriers has not been investigated extensively to date (73).
In addition to the obvious differences in fenestrated capillaries within the CVOs and the barrier-forming microvessels within the CNS, regional differences in the characteristics of the BBB have also been described. For example, mouse endothelioma cells established from the cerebellum respond in a more pronounced fashion than cerebral endotheliomas to proinflammatory cytokines by increased permeability and reduced transendothelial electrical resistance (74).
Molecular and cellular differences between meningeal and parenchymal microvascular beds have also been described (75, 76); meningeal microvessels lack astrocytic ensheathment. Interestingly, the differences between meningeal and parenchymal CNS blood vessel endothelial cells extend to differences in their expression patterns of P- and E-selectin. In the healthy CNS, meningeal blood vessel endothelial cells can be distinguished from those in the CNS parenchyma by their constitutive expression of P-selectin, which is absent from endothelial cells of parenchymal blood vessels (30, 77, 78). Furthermore, injection of proinflammatory cytokines into mice induced expression of E-selectin in meningeal but not in parenchymal CNS blood vessel endothelial cells (79). Thus, leukocytes that extravasate across meningeal vessels arrive in the leptomeningeal space from which they might travel within the perivascular spaces; if confronted with an inflammatory stimulus, they could enter the CNS parenchyma. Meningeal blood vessels have been described as being leakier than parenchymal blood vessels and more reactive to proinflammatory cytokines, and this might contribute to leukocyte recruitment restricted to the meningeal compartment.
In summary, we have proposed that the term BBB is somewhat of a misnomer. The barrier concept is more applicable to solute entry, the neuroinflammatory relevance of which relates more to edema than to cellular migration. The process of leukocyte entry into the CNS parenchyma is controlled by different cellular components at the level of postcapillary venules. Thus, we highlight the concept that regulation of cellular entry involves migration across 2 distinct structures, the vascular wall and the glia limitans and their associated basement membranes. This migration involves 2 steps for the development of neuroinflammation.
The authors acknowledge discussions within the COST Action BM0603 Inflammation in Brain Disease Neurinfnet and networking support from COST.